本文選題：手助腹腔鏡手術(shù) + 腹腔鏡輔助手術(shù)�。� 參考：《重慶醫(yī)學(xué)》2017年17期

【摘要】：目的比較腹腔鏡輔助手術(shù)(LAS)與手助腹腔鏡手術(shù)(HALS)在結(jié)直腸癌(CRC)根治術(shù)中的應(yīng)用價(jià)值及短期治療效果,以及體質(zhì)量指數(shù)(BMI)對(duì)手術(shù)結(jié)局的影響。方法對(duì)近5年內(nèi)在邢臺(tái)市人民醫(yī)院接受手術(shù)治療的120例CRC患者病例資料進(jìn)行回顧分析,按手術(shù)術(shù)式的不同分別定義為L(zhǎng)AS組(58例)與HALS組(62例),另以BMI指數(shù)為分組依據(jù)分為非超重組(53例)與超重組(67例),統(tǒng)計(jì)患者的一般資料、手術(shù)相關(guān)指標(biāo)(包括手術(shù)時(shí)間、麻醉時(shí)間、ASA分級(jí)、術(shù)中出血量、淋巴結(jié)清掃個(gè)數(shù)、刀口長(zhǎng)度、Trocar使用數(shù)量及中轉(zhuǎn)開腹等)、術(shù)后恢復(fù)指標(biāo)(包括術(shù)后進(jìn)食時(shí)間、留置導(dǎo)尿時(shí)間及住院時(shí)間)、術(shù)后并發(fā)癥及隨訪情況。結(jié)果 HALS組的手術(shù)時(shí)間與麻醉時(shí)間較LAS組均顯著縮短(P0.01),非超重組中接受HALS患者的手術(shù)時(shí)間為(83.52±18.14)min,接受LAS患者為(90.03±27.54)min,二者比較差異無統(tǒng)計(jì)學(xué)意義(P0.05);超重組中接受HALS患者為(91.37±15.81)min,接受LAS患者為(135.02±22.59)min,二者比較差異有統(tǒng)計(jì)學(xué)意義(P0.01);HALS組患者術(shù)中出血量與Trocar使用數(shù)量較LAS組均明顯減少(P0.01);HALS組未有中轉(zhuǎn)開腹病例,LAS組中轉(zhuǎn)開腹2例;在超重組中接受LAS治療患者的手術(shù)時(shí)間更長(zhǎng)(P0.01);LAS組與HALS組的術(shù)后進(jìn)食時(shí)間、術(shù)后留置導(dǎo)尿時(shí)間及住院時(shí)間組間比較,差異均無統(tǒng)計(jì)學(xué)意義(P0.05);LAS組與HALS組的術(shù)后鎮(zhèn)痛、感染、吻合口瘺及住院期間再手術(shù)等指標(biāo)比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05);隨訪期間LAS組發(fā)生切口疝、復(fù)發(fā)轉(zhuǎn)移與死亡病例各1例,HALS組發(fā)生復(fù)發(fā)轉(zhuǎn)移1例。結(jié)論 LAS與HALS兩種術(shù)式均可作為CRC的常規(guī)術(shù)式,但HALS較LAS在縮短手術(shù)時(shí)間方面更具優(yōu)勢(shì),肥胖CRC患者應(yīng)優(yōu)先選用HALS術(shù)式。
[Abstract]:Objective to compare the application value of LAS-assisted laparoscopic surgery (LAS) and hand-assisted laparoscopic surgery (HALS) in radical resection of colorectal carcinoma and the effect of BMII on the outcome of operation. Methods the data of 120 patients with CRC who received surgical treatment in Xingtai people's Hospital in recent 5 years were retrospectively analyzed. According to the different operative methods, 58 cases of Las group and 62 cases of Hals group were divided into two groups: the BMI index was divided into 53 cases of non-superrecombination group and 67 cases of hyperrecombination group. The general data of the patients and the operative time (including the time of operation) were analyzed. Anaesthesia time and ASA grade, intraoperative bleeding volume, number of lymph node dissection, length of knife edge and Trocar usage and conversion to laparotomy, postoperative recovery index (including postoperative feeding time, indwelling catheterization time and hospitalization time), postoperative complications and follow-up. Results the time of operation and anesthesia in Hals group was significantly shorter than that in Las group. The operative time of patients receiving Hals in non-superrecombination group was 83.52 鹵18.14 min and that in Las group was 90.03 鹵27.54 min. There was no significant difference between the two groups. For 91.37 鹵15.81 min and 135.02 鹵22.59 min in patients receiving Las, there was a significant difference between the two groups. The amount of intraoperative bleeding and the amount of Trocar in Hals group were significantly lower than those in Las group. The postoperative feeding time, postoperative catheterization time and hospitalization time of patients receiving Las in superrecombination group were longer than those in the control group and Hals group. There was no significant difference in postoperative analgesia and infection between the two groups. There was no significant difference in anastomotic fistula and reoperation during hospitalization, while incisional hernia occurred in Las group during follow-up, and recurrence and metastasis occurred in 1 case in Hals group and 1 case in Hals group during follow-up. Conclusion Las and Hals can be used as routine operation for CRC, but Hals is superior to Las in shortening operative time. Hals should be preferred in obese CRC patients.
【作者單位】： 河北省邢臺(tái)市人民醫(yī)院普外科;邢臺(tái)醫(yī)學(xué)高等專科學(xué)技第二附屬醫(yī)院普外科;河北省邢臺(tái)市人民醫(yī)院CTMR室;
【分類號(hào)】：R735.34

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